ST. MARTIN'S IN THE PINES
Address
4941 MONTEVALLO ROAD
BIRMINGHAM, AL 35210
(205) 956-1831
Nursing Home Ratings
Health Inspections | |
Quality Measures | |
Nursing Staff | |
R.N. Staff Only | |
Overall Rating |
Percent of Beds Occupied
Number of Residents and Certified Beds
- Residents: 134
- Certified Beds: 138
This Facility Accepts
- Medicare
- Medicaid
Operational Details
- Operated By Non Profit - Church Related
- Offers Both Resident and Family Counseling Services
- Part of a Continuing Care Retirement Community (CCRC)
- This Facility is Not Part of a Chain or Franchise
Resident Services
The information below lists services this facility has provided for residents from October through December 2010. During this period, the most common type of service provided was "Ultra-High Rehabilitation". To get a better idea of the types of services that are commonly performed, compare the "Percent of Service Days" column below. These services are based on submitted claims to Medicare and do not provide a complete overview of all the services provided by St. Martin's in the Pines. For more information read our guide on how nursing facilities are reimbursed, types of services, and ADL index scores.
Resident Services | Resident Conditions | Percent of Service Days |
Ultra-High Rehabilitation Plus Extensive Services
- At least one rehabilitation discipline five days/week
- A second rehabilitation discipline three days/week
- Tracheostomy care
- Ventilator or respirator
- Isolation for active infectious disease while a resident
- Activities of Daily Living (ADL) score of 2 or more
ADL Index Range: 2-10 | 0.3% |
Total Percent: | 0.3% |
Ultra-High Rehabilitation
- At least one rehabilitation discipline five days/week
- A second rehabilitation discipline three days/week
ADL Index Range: 11-16 | 19.2% |
ADL Index Range: 6-10 | 20.4% |
ADL Index Range: 0-5 | 24.0% |
Total Percent: | 63.6% |
Very High Rehabilitation
- At least one rehabilitation discipline five days/week
ADL Index Range: 11-16 | 4.1% |
ADL Index Range: 6-10 | 12.1% |
ADL Index Range: 0-5 | 14.2% |
Total Percent: | 30.4% |
High Rehabilitation
- At least one rehabilitation discipline five days/week
ADL Index Range: 11-16 | 1.0% |
Total Percent: | 1.0% |
Medium Rehabilitation
- Five days any combination of three rehabilitation disciplines
ADL Index Range: 11-16 | 4.0% |
ADL Index Range: 6-10 | 0.3% |
Total Percent: | 4.2% |
Special Care High
- Comatose
- Septicemia
- Diabetes with daily injections and a change of order two or more days
- Quadriplegia with ADL score greater or equal to 5
- Chronic Obstructive Pulmonary Disease (COPD) and shortness of breath when lying flat
- Fever with pneumonia, or vomiting, or weight loss, or feeding tube
- Parenteral/IV feedings
- Respiratory therapy for 7 days
- Activities of Daily Living (ADL) score of 2 or more
ADL Index Range: 6-10 - No Signs of depression | 0.3% |
Total Percent: | 0.3% |
Clinically Complex
- Pneumonia, hemiplegia with ADL score >=5
- Surgical wounds or open lesions with treatment
- Burns
- Chemotherapy while a resident
- Oxygen therapy while a resident
- IV medications or transfusions while a resident
- Extensive Services, Special Care High or Special Care Low qualifier and ADL score of 0 or 1
ADL Index Range: 11-14 - No Signs of depression | 0.2% |
Total Percent: | 0.2% |
Rating Details For St. Martin's in the Pines
Nursing Staff -
The nursing staff is the most important part of what determines the quality of care and comfort of a resident in a nursing home. Government regulations set expectations on time spent with each resident based on the services being provided. The breakdown below lists the nursing types (RN, LPN, LVN, CNA) and a comparison of the reported and expected hours per resident per day.
Nursing Hours Per Resident Per Day | Reported | Expected |
Registered Nurse (RN) Hours | 22 Minutes | 1 Hour and 14 Minutes |
Licensed Practical/Vocational Nurse (LPN/LVN) Hours | 1 Hour and 14 Minutes | 44 Minutes |
Certified Nursing Assistant (CNA) Hours | 3 Hours and 31 Minutes | 2 Hours and 33 Minutes |
Total Licensed Nurse Hours | 1 Hour and 36 Minutes | 1 Hour and 57 Minutes |
Total Nurse Hours | 5 Hours and 6 Minutes | 4 Hours and 30 Minutes |
Quality of Care -
Medicare determines quality of care ratings for nursing facilities by surveying several "quality measures", which are broken down into long-term and short-term stay residents, as well as if the action is preventive or if there is a deficiency in the quality of care. State averages for Alabama are also provided for comparison purposes. Note: Figures below are averaged over the past nine months.
This Facility | Alabama Average |
Long-Term Stay Preventive Actions
Percent of Long-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination | 86% | 90% |
Percent of Long-Stay Residents Given Influenza Vaccination During the Flu Season | 90-100% | 90% |
Long-Term Stay Deficiencies
Percent of Long-Stay Residents Whose Need for Help with Daily Activities Has Increased | 21% | 10% |
Percent of Long-Stay Residents Who Were Physically Restrained | 1% | 4% |
Percent of Long-Stay Residents Who Are More Depressed or Anxious | 21% | 9% |
Percent of High-Risk Long-Stay Residents Who Have Pressure Sores | 5% | 9% |
Percent of Low-Risk Long-Stay Residents Who Lose Control of Their Bowels or Bladder | 76% | 48% |
Percent of Long-Stay Residents Who Had a Urinary Tract Infection | 8% | 8% |
Percent of Long-Stay Residents Who Have/Had a Catheter Inserted and Left in Their Bladder | 3% | 4% |
Percent of Long-Stay Residents Who Spend Most of Their Time in Bed or in a Chair | 2% | 7% |
Percent of Long-Stay Residents Who Have Moderate to Severe Pain | 1% | 3% |
Percent of Long-Stay Residents Whose Ability to Move About in and Around Their Room Got Worse | 19% | 8% |
Percent of Low-Risk Long-Stay Residents Who Have Pressure Sores | - | 2% |
Percent of Long-Stay Residents Who Lose Too Much Weight | 24% | 8% |
Short-Term Stay Preventive Actions
Percent of Short-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination | 55% | 81% |
Percent of Short-Stay Residents Given Influenza Vaccination During the Flu Season | 90-100% | 82% |
Short-Term Stay Deficiencies
Percent of Short-Stay Residents Who Have Pressure Sores | 7% | 12% |
Percent of Short-Stay Residents Who Had Moderate to Severe Pain | 12% | 14% |
Percent of Short-Stay Residents Who Have Delirium | 1% | 2% |
Health Inspection Details -
All Medicare and/or Medicaid certified nursing home must undergo health inspections on average once a year, but may be more frequent if the facility is peforming poorly. These inspections cover most aspects of life in a nursing home, and are broken down into deficiencies types, which including: Pharmacy Service, Administration, Resident Rights, Nutrition and Dietary, Resident Assessment, Environmental, and Mistreatment. Below are the list of deficiencies found by inspectors in the past few years along with the degree of harm and how many residents may have been affected. Note: The most recent health survey was on 05/20/2011.
Degree of Harm
- - Potential for Minimal Harm
- - Minimal Harm or Potential for Harm
- - Resident Harmed
- - Immediate Jeopardy to Resident Health
Residents Affected
- - Isolated
- - Some Residents
- - Many Residents
Deficiencies Found By Inspectors | Degree of Harm | Residents Affected |
Administration
Keep Accurate and Appropriate Medical Records.
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Give or Get Lab Tests to Meet the Needs of Residents.
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Quickly Tell the Resident's Doctor the Results of Lab Tests.
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Keep Accurate and Appropriate Medical Records.
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Environmental
Provide Needed Housekeeping and Maintenance.
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Make Sure That the Nursing Home Area is Free of Dangers That Cause Accidents.
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Make Sure That the Nursing Home Area is Free of Dangers That Cause Accidents.
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Make Sure That the Nursing Home Area is Free of Dangers That Cause Accidents.
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Keep All Essential Equipment Working Safely.
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Nutrition and Dietary
Store, Cook, and Give out Food in a Safe and Clean Way.
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Make Sure That Residents Are Well Nourished.
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Store, Cook, and Give out Food in a Safe and Clean Way.
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Pharmacy Service
1) Make Sure That Residents Who Take Drugs Are Not Given Too Many Doses or for Too Long; 2) Make Sure That the Use of Drugs is Carefully Watched; or 3) Stop or Change Drugs That Cause Unwanted Effects.
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Have Drugs and Other Similar Products Available, Which Are Needed Every Day and in Emergencies, and Give Them out Properly.
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1) Make Sure That Residents Who Take Drugs Are Not Given Too Many Doses or for Too Long; 2) Make Sure That the Use of Drugs is Carefully Watched; or 3) Stop or Change Drugs That Cause Unwanted Effects.
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1) Make Sure That Residents Who Take Drugs Are Not Given Too Many Doses or for Too Long; 2) Make Sure That the Use of Drugs is Carefully Watched; or 3) Stop or Change Drugs That Cause Unwanted Effects.
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Have Drugs and Other Similar Products Available, Which Are Needed Every Day and in Emergencies, and Give Them out Properly.
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Quality Care
Make Sure That Residents Receive Treatment/Services to Continue to Be Able to Care for Themselves, Unless a Change is Unavoidable.
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Give Residents Proper Treatment to Prevent New Bed (Pressure) Sores or Heal Existing Bed Sores.
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Make Sure That Each Resident's Nutritional Needs Were Met.
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Give Professional Services That Meet a Professional Standard of Quality.
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Give Professional Services That Follow Each Resident's Written Care Plan.
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Make Sure That Each Resident Who Enters the Nursing Home Without a Catheter is Not Given a Catheter, Unless It is Necessary.
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Resident Assessment
Do an Assessment of the Resident Every Year.
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Keep Assessments Completed in the Preceding 15 Months in the Resident's Active Record.
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Provide a Final Summary of the Resident's Health Status and a Summary of the Resident's Stay, when the Resident is Ready to Leave the Nursing Home.
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1) Develop a Complete Care Plan Within 7 Days of Each Resident's Admission; 2) Prepare a Care Plan with the Care Team, Including the Primary Nurse, Doctor, Resident or Resident's Family or Representative; or 3) Check and Update the Care Plan.
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Resident Rights
Try to Resolve Each Resident's Complaints Quickly.
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Make Sure Each Resident Has the Right to Choose Activities, Schedules and Health Care According to His or Her Interests, Assessment, and Plan of Care.
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Enforcement
Below is a list of any civil penalities or denials of payment for new admissions (DPNA) that this facility received in the previous three years. Note: Monetary figures are not available for DPNAs.
Action Taken | Date | Amount |
Civil Money Penalty (CMP) | 07/15/2010 | $6,500 |
Deficiencies from Complaints and Incidents
The table below lists incident reports by the nursing staff or administration for St. Martin's in the Pines, as well as complaints by residents or their family in the previous three years.
Degree of Harm
- - Potential for Minimal Harm
- - Minimal Harm or Potential for Harm
- - Resident Harmed
- - Immediate Jeopardy to Resident Health
Residents Affected
- - Isolated
- - Some Residents
- - Many Residents
Formal Complaints | Degree of Harm | Residents Affected |
Administration
Make Sure That Nurse Aides Show They Have the Skills to Be Able to Care for Residents.
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Environmental
Have a Program to Keep Infection from Spreading.
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Have a Program to Keep Infection from Spreading.
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Resident Assessment
Develop a Complete Care Plan That Meets All of a Resident's Needs, with Timetables and Actions That Can Be Measured.
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Fire Safety
Nursing homes certified by Medicare and/or Medicaid are required to have fire safety inspections to meet Life Safety Code (LSC) standards. Below is a list of deficiencies that St. Martin's in the Pines had in recent fire safety inspections. This information can be used to see if all standards were met, the degree of harm, the number of residents affected, and the date when deficiencies were corrected. Note: The most recent fire safety survey was on 05/25/2011.
Degree of Harm
- - Potential for Minimal Harm
- - Minimal Harm or Potential for Harm
- - Resident Harmed
- - Immediate Jeopardy to Resident Health
Residents Affected
- - Isolated
- - Some Residents
- - Many Residents
Deficiencies Found By Inspectors | Degree of Harm | Residents Affected |
Automatic Sprinkler Systems
An Approved Automatic Sprinkler System Connected to the Fire Alarm System.
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Automatic Sprinkler Systems That Have Been Maintained in Working Order.
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Portable Fire Extinguishers.
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Automatic Sprinkler Systems That Have Been Maintained in Working Order.
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An Approved Automatic Sprinkler System Connected to the Fire Alarm System.
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Automatic Sprinkler Systems That Have Been Maintained in Working Order.
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Building Service Equipment
Properly Protected Cooking Facilities.
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Heating and Ventilation Systems That Have Been Properly Installed According to the Manufacturer's Instructions.
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Properly Protected Cooking Facilities.
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Properly Protected Cooking Facilities.
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Restrictions on the Use of Portable Space Heaters.
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Corridor Walls and Doors
Corridor and Hallway Doors That Block Smoke.
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Corridor and Hallway Doors That Block Smoke.
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Signs That State That Exit Doors Are to Be Kept Closed.
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Corridor and Hallway Doors That Block Smoke.
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Electrical
Weekly Inspections and Monthly Testing of Generators.
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Properly Installed Electrical Wiring and Equipment.
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A Separate and Independent Backup Electrical Power Source.
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Properly Installed Electrical Wiring and Equipment.
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Emergency Plans and Fire Drills
Record of Quarterly Fire Drills for Each Shift Under Varying Conditions.
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Exits and Egress
Exits That Are Accessible at All Times.
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Exits That Are Accessible at All Times.
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Fire Alarm Systems
An Approved Installation, Maintenance and Testing Program for Fire Alarm Systems.
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An Approved Installation, Maintenance and Testing Program for Fire Alarm Systems.
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Properly Maintained Smoke Detectors.
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An Approved Installation, Maintenance and Testing Program for Fire Alarm Systems.
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Hazardous Area
Construction That Can Resist Fire for One Hour or an Approved Fire Extinguishing System.
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Construction That Can Resist Fire for One Hour or an Approved Fire Extinguishing System.
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Construction That Can Resist Fire for One Hour or an Approved Fire Extinguishing System.
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Illumination and Emergency Power
Proper Backup Exit Lighting.
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Medical Gases and Anesthetizing Areas
Proper Medical Gas Storage and Administration Areas.
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Miscellaneous
Fire Safety Features Required by Current Fire Safety Codes.
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Smoke Compartmentation and Control
Walls or Barriers That Prevent Smoke from Passing Through and Would Resist Fire for at Least One Hour.
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Enough Space Near Smoke Barriers to Protect Residents.
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Enough Space Near Smoke Barriers to Protect Residents.
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Smoke Barrier Doors That Can Resist Smoke for at Least 20 Minutes.
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Walls or Barriers That Prevent Smoke from Passing Through and Would Resist Fire for at Least One Hour.
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Smoke Barrier Doors That Can Resist Smoke for at Least 20 Minutes.
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Vertical Openings
Proper Stairway Enclosures and Vertical Shafts.
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Exit Doors That Are Held Open by Devices That Will Automatically Close on the Activation of a Fire Alarm or Smoke Detectors.
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